Japanese Encephalitis- and Dengue-Associated Acute Encephalitis Syndrome Cases in Myanmar

Aung Kyaw Kyaw Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;
Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin, Mandalay Region, Myanmar;

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Mya Myat Ngwe Tun Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;

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Takeshi Nabeshima Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;

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Corazon C. Buerano Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;
Research and Biotechnology, St. Luke’s Medical Center, Quezon City, Philippines;

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Tsuyoshi Ando Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;

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Shingo Inoue Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;

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Daisuke Hayasaka Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;

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Chang-Kweng Lim Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan

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Masayuki Saijo Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan

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Hlaing Myat Thu Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin, Mandalay Region, Myanmar;

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Kyaw Zin Thant Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin, Mandalay Region, Myanmar;

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Kouichi Morita Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan;

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This study was conducted to find the burden of dengue virus (DENV) and Japanese encephalitis virus (JEV) among children under the age of 13, who presented with acute encephalitis syndrome at Mandalay Children Hospital in Myanmar in 2013. Molecular and serological investigations were performed on 123 cerebrospinal fluid (CSF) samples collected from these patients. By neutralization tests and/or virus isolation, four (3.3%) JEV- and one DENV-associated encephalitis cases (0.8%) were confirmed. Antibody titer against JEV Genotype 3 was the highest among the laboratory-confirmed JEV cases. One strain of DENV-1 with Genotype 1 was isolated from the CSF sample of the dengue encephalitis patient; this was similar to the virus circulating in the study area and neighboring countries. This study shows that flaviviruses are important pathogens causing encephalitis in Myanmar. Active disease surveillance, vector control, and vaccination programs should be enforced to reduce the morbidity and mortality caused by flavivirus encephalitis.

Author Notes

Address correspondence to Mya Myat Ngwe Tun, Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan. E-mail: myamyat@tm.nagasaki-u.ac.jp

Financial support: This work was supported by the Japan Initiative for Global Research Network on Infectious Diseases (JGRID, 18fm0108001); Japan–United States Cooperative Medical Science Program from Japan Agency for Medical Research and Development (AMED, JP18fk0108035); Research Program on Emerging and Re-emerging Infectious Diseases of the Japan Agency for Medical Research and Development (AMED) under Grant Number (17fk0108108h1401); and Joint Usage/Research Center on Tropical Disease, Institute of Tropical Medicine, Nagasaki University.

Authors’ addresses: Aung Kyaw Kyaw, Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan, and Virology Research Division, Department of Medical Research, Pyin Oo Lwin, Myanmar, E-mail: akkyawdmr@gmail.com. Mya Myat Ngwe Tun, Takeshi Nabeshima, Tsuyoshi Ando, Shingo Inoue, Daisuke Hayasaka, and Kouichi Morita, Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan, E-mails: myamyat@tm.nagasaki-u.ac.jp, mtmikami@tm.nagasaki-u.ac.jp, t-ando@tm.nagasaki-u.ac.jp, pampanga@nagasaki-u.ac.jp, hayasaka@nagasaki-u.ac.jp, and moritak@nagasaki-u.ac.jp. Corazon C. Buerano, Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan, and Research and Biotechnology, St. Luke’s Medical Center, Quezon City, Philippines, E-mail: ccbuerano@hotmail.com. Chang Kweng Lim and Masayuki Saijo, Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan, E-mails: ck@nih.go.jp and msaijo@nih.go.jp. Hlaing Myat Thu and Kyaw Zin Thant, Virology Research Division, Department of Medical Research, Pyin Oo Lwin, Myanmar, E-mails: hmyatthu28@gmail.com and drkz.thant@googlemail.com.

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